Even though this "wave" has been fairly minimal in terms of the local impact (for us) so far, it has taken quite a toll on our department from the resource and fiscal standpoint. If this was more widespread and had serious imapacts (mortality-wise), it would obviously be even more devastating to us.

Actions taken to address the issue(s):

We are using this event as a good dry run as to what a real and sustained pandemic would be like. We are identifying our gaps and continuing to engage our local partners in an effort to ONCE AGAIN raise awareness regarding preparedness and are re-emphasizing the importance of planning now for the next potential wave(s) of this outbreak with foreseeable higher severity.

Outcomes that resulted from actions taken:

We are the second largest county in Indiana in terms of population -- first in geographic size. When you see the national, midwest and even Indiana averages regarding public health workers per one hundred thousand population -- we are woefully understaffed. Our average is 16.5 per 100,00 population. That's sickening! We are seeing how critical that is during such an emergency. We've tapped into our staff in a way that would only increase dramatically if this were a really devastating event. I'm seriously concerned about how we'd function in a truly overwhelming crisis. We have also found that the response from our Medical Reserve Corps volunteers has been somewhat dismal because the assistance we've needed has been during the workday and our rostered volunteers are primarily those who are employed and volunteer when there are after hours events. In a true disaster, where we'd be functioning on 12 hour shifts and in 24 hours periods -- I'm unsure how we'll meet the demand. The overall staffing/resource issues have been brought to light in the wake of this disaster.

The impact fiscally here has been in terms of overtime payment to staff who have been making 4-hour labe specimen deliveries to the state department of health (two hours away), nurses staffing phone banks for physician and public calls, and for communications folks and I/T folks assisting us in getting the message out and keeping our technology functioning. We don't have "cushion" budgets for discretionary use during disasters for overtime payments, etc. This is a huge expense that will cause me to "rob Peter to pay Paul" for lack of a better way of putting it. I'm uncertain how we'd sustain payment for needed staff during a long-term disaster. This is my single biggest concern -- along with how we'd pay to feed them, possibly house them, buy medical and PPE supplies, etc.

Finally -- the amount of change to the daily guidance (from CDC) has made keeping our partners informed and "ready" very difficult. We have appreciated the CDC guidance immensely as it has answered many of the issues we've been faced with locally. However, when guidance changes daily -- it frustrates your partners. We've been attempting to inform them that this is how it would be in a sustained event. We understand the guidance changes due to the emerging scientific information -- but the public and your agency partners views this as indecisiveness. The message needs to be continuously reiterated by the CDC that it's normal and warranted to see daily changes in guidance (such as school closures, etc.)

Thanks for listening and we appreciate your assistance.

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